When Can I Bill for a Reevaluation

April 8, 2019
Rick Gawenda

I receive many questions concerning when is it appropriate to bill for a reevaluation to an insurance carrier. A few of the questions I receive are:

  1. Can I bill for a reevaluation for when I’m required to complete a Progress Report on a Medicare patient or for that matter, any patient?
  2. Can I bill for a reevaluation because my state practice act requires I perform a reevaluation at certain timeframes from the start of care?
  3. Can I bill a reevaluation when I’m already seeing a patient for one condition/diagnosis and while still treating that condition, they bring in a referral for a second condition/diagnosis that’s unrelated to the first condition/diagnosis?

In this article, I will answer the above 3 questions and also provide you with the criteria when a reevaluation is appropriate to bill, not only to the Medicare program, but to any insurance carrier. But did you also know that beginning on January 1, 2017, not only must the criteria be met, but the physical therapist must meet 2 additional requirements and the occupational therapist 3 additional requirements due to the new reevaluation CPT codes that became effective January 1, 2017? In this article, I will also provide you with those additional requirements.

Lets begin!

First, let me provide the criteria that must be met in order for the therapist to bill a reevaluation to the Medicare program or any other insurance carrier. A reevaluation may be considered reasonable and necessary in the following situations:

The content here is for members only log in here or sign up.

All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.

This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

  1. I am often asked if billing a Re-evaluation is appropriate for a planned discharge? for both PT and OT

  2. If a patient has been discharged for a condition and then comes back several weeks (or months) later with the same complaint, would it ever be appropriate to charge a reevaluation? Could this be an option for payers who have limitations on the number of evaluations that can be performed during a certain time period?

    1. My opinion only is it would be a new evaluation since you are discharged them for whatever reason.